Damhus Christina Sadolin, Quentin Julie Greve, Malmqvist Jessica, Siersma Volkert, Brodersen John
The Section and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; The Primary Health Care Research Unit, Region Zealand, Denmark.
The Section and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Lung Cancer. 2021 May;155:46-52. doi: 10.1016/j.lungcan.2021.03.003. Epub 2021 Mar 10.
Participation in lung cancer CT-screening can be associated with a need for follow-up procedures. The screening and waiting for test results introduce the risk of experiencing psychosocial consequences. Therefore, the aims of this study were: 1) To investigate if the psychosocial consequences changed from before an annual screening round to before a three-month follow-up CT-scan in participants with a positive screening result. 2) To investigate potential differences in psychosocial consequences between false positives (FP) and true positives (TP). FP were defined as those where cancer was not confirmed in the follow-up CT-scan and TP where it was.
This longitudinal study was based on data from the Danish Lung Cancer Screening Trial (DLCST). The Consequences of Screening - Lung cancer (COS-LC) questionnaire was used to measure psychosocial consequences among 130 participants who all received an abnormal CT-screening result at their annual screening round. Eligible participants completed the COS-LC before their annual CT-screening and before the three-month follow-up.
We found a statistically significant increase in negative psychosocial consequences between the annual lung cancer CT-screening and the three-month follow-up CT-scan in four of nine psychosocial scales; Sense of dejection, Self-blame, Focus on airway symptoms and Harm of smoking. Furthermore, an increase, however not statistically significant, was identified in all remaining scales, except for the scale Stigmatisation which was slightly decreased. We found no evidence of an association between psychosocial consequences and diagnostic groups, FP and TP.
An increase in negative psychosocial consequences was observed between the annual lung cancer CT-screening and the three-month follow-up CT-scan. Since we found no statistically significant difference between the diagnostic groups, the increase in negative psychosocial consequences is interpreted as a nocebo effect of living three months in uncertainty not knowing if one's positive CT-screening result was true or false.
参与肺癌CT筛查可能需要进行后续检查。筛查及等待检查结果会带来心理社会影响方面的风险。因此，本研究的目的是：1）调查筛查结果呈阳性的参与者在年度筛查轮次之前到三个月随访CT扫描之前心理社会影响是否发生变化。2）调查假阳性（FP）和真阳性（TP）之间心理社会影响的潜在差异。FP定义为在后续CT扫描中未确诊癌症的情况，TP定义为确诊癌症的情况。
这项纵向研究基于丹麦肺癌筛查试验（DLCST）的数据。使用肺癌筛查后果（COS-LC）问卷来测量130名参与者的心理社会影响，这些参与者在年度筛查轮次中均获得了异常的CT筛查结果。符合条件的参与者在年度CT筛查之前和三个月随访之前完成了COS-LC问卷。
我们发现，在九个心理社会量表中的四个量表上，年度肺癌CT筛查和三个月随访CT扫描之间负面心理社会影响有统计学显著增加；沮丧感、自责、关注气道症状和吸烟危害。此外，除了耻辱感量表略有下降外，其余所有量表均有增加，但无统计学显著性。我们没有发现心理社会影响与诊断组、FP和TP之间存在关联的证据。
在年度肺癌CT筛查和三个月随访CT扫描之间观察到负面心理社会影响有所增加。由于我们发现诊断组之间没有统计学显著差异，负面心理社会影响的增加被解释为在三个月的不确定性中生活的一种反安慰剂效应，不知道自己的阳性CT筛查结果是真是假。
